Keys Life
More on valley fever and a tough diagnosis

By DR. DOUG MADER Special to The Citizen

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Q: Hello Dr. Mader: I saw your column about valley fever. I have a dog that may also have that, and I had a few questions for you. Would you be willing to give me your opinion? Here is a brief synopsis of my dog's problem. My dog Sader started limping about two years ago. The vet took X-rays and they showed a cloud in the tibia/fibula [lower leg] area. Vets assumed it was valley fever ,but titers were very low, not enough for positive diagnosis. Sader had relief with Fluconazol. A year later, the limp started again so Fluconazol was doubled and she again had relief. Since then, a lump on her knee has developed. A second set of X-rays showed the cloud has increased, along with some degeneration that does not look like valley fever but it doesn't look like cancer either. A biopsy of the affected area on the bone shows some abnormal cells, but is inconclusive. The oncologist thinks it's a slow-moving cancer. Recent blood work shows 0 titers and hypothyroidism -- the vet wants more blood work to confirm.

So the long and short of it is nobody knows and they are all guessing and, of course, they all want to do more and more tests just to confirm they don't know. I'm being told amputation is the way to go, but I would like to save the leg if I can. I really think it is a fungus or bacteria that affects bone. I really don't think its cancer, especially with the two improvements with Fluconazol. Do you have any suggestions? Any help would be greatly appreciated. I currently have continued her Fluconazol and have added garlic and oregano oil. Thank you for taking the time to read this. Keith O.

A: I am very sorry to hear about your dog. It is hard for me to say what is going on without seeing your dog or the X-rays.

Bottom line: You need to have the bone re-biopsied. As you know, bone biopsy results can be frustrating -- this is not unique to your dog. You have to get large samples, generally from more than one site.

Regarding Fluconazole, it is generally not the drug of choice to treat valley fever. Ketoconazole or Itraconazole are the preferred drugs for this disease. There is a new anti-fungal, called Vorconazole, that is even more effective, but unfortunately it's extremely expensive.

Were X-rays taken of your dog's lungs? Was an electrophoresis ever taken?

Valley fever is not the only fungus that can cause lesions, and the low titers may be due to infection from some other cause.

I am also doubtful that your dog is hypothyroid. It is common for thyroid levels to drop below normal in dogs with chronic disease as Sader has been experiencing. This can occur from any number of diseases, not just valley fever.

Unfortunately, cancer is high on the list of possibilities, but so is a smoldering bacterial infection. Neither of these would respond to antifungals.

On a final note: Amputation, if necessary, is an option that should be considered. Dogs do extremely well without a leg. It is generally harder on the owner than it is on the pet.

Dr. Mader is an ABVP Board Certified veterinary specialist practicing in the Keys. Send your questions to

Published Sunday, December 7, 2008